Provider Demographics
NPI:1235028242
Name:JEMILUGBA, OLUBUKOLA C
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:C
Last Name:JEMILUGBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BROAD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1243
Mailing Address - Country:US
Mailing Address - Phone:862-300-5569
Mailing Address - Fax:973-791-9955
Practice Address - Street 1:12 BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1243
Practice Address - Country:US
Practice Address - Phone:862-300-5569
Practice Address - Fax:973-791-9955
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health